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An Overview
NIAID
Food Allergy
An Overview
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases NIH Publication No. 12-5518 July 2012 www.niaid.nih.gov
Contents
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Introduction What Is Food Allergy? What Is an Allergic Reaction to Food? What Is Anaphylaxis? Common Food Allergies in Infants, Children, and Adults Milk Allergy in Infants and Children Is It Food Allergy or Food Intolerance? Diagnosing Food Allergy Preventing and Treating Food Allergy Food Allergy Research at NIAID Glossary More Information Credits
NIAID I FOOD ALLERGY
Introduction
All of us eat to survive, and most of us enjoy eating. However, recent studies have found that almost 1 in 20 young children under the age of 5 years and almost 1 in 25 adults are allergic to at least one food. Other studies indicate that food allergy, especially allergy to peanut, is on the rise. As a result, more and more people are becoming aware of food allergy, making it a subject of increasing public concern. When one person in a family has a food allergy, the whole family is affected. There may be day-to-day anxiety that a loved one may accidentally eat a food that could lead to anaphylaxis, a dangerous allergic reaction. This booklet will help you understand allergic reactions to foods and their possible causes, and it explains how a healthcare professional diagnoses and treats food allergy. If you suspect you or a member of your family have a food allergy, consult your healthcare professional for medical advice.
Note: Words in bold are defined in the glossary at the end of this booklet.
Step 2: The next time you are exposed to the same food allergen, it binds to the IgE antibodies that are attached to the mast cells and basophils. The binding signals the cells to release massive amounts of chemicals such as histamine. Depending on the tissue in which they are released, these chemicals will cause you to have various symptoms of food allergy. The symptoms can range from mild to severe. A severe allergic reaction can include a potentially life-threatening reaction called anaphylaxis. Generally, you are at greater risk for developing a food allergy if you come from a family in which allergies are common. These allergies are not necessarily food allergies but perhaps other allergic diseases, such as asthma, eczema (atopic dermatitis), or allergic rhinitis (hay fever). If you have two parents who have allergies, you are more likely to develop food allergy than someone with one parent who has allergies. An allergic reaction to food usually takes place within a few minutes to several hours after exposure to the allergen. The process of eating and digesting food and the location of mast cells both affect the timing and location of the reaction.
Worsening of eczema Tightening of the throat or trouble breathing Drop in blood pressure
EOSINOPHILIC ESOPHAGITIS
Eosinophilic esophagitis (EoE) is a newly recognized chronic disease that can be associated with food allergies. It is increasingly being diagnosed in children and adults. Symptoms of EoE include nausea, vomiting, and abdominal pain after eating. A person may also have symptoms that resemble acid reflux from the stomach. In older children and adults, it can cause more severe symptoms, such as difficulty swallowing solid food or solid food sticking in the esophagus for more than a few minutes. In infants, this disease may be associated with failure to thrive. If you are diagnosed with EoE, you will probably be tested for allergies. In some situations, avoiding certain food allergens will be an effective treatment for EoE.
What Is Anaphylaxis?
If you have a food allergy, there is a chance that you may experience a severe form of allergic reaction known as anaphylaxis. Anaphylaxis may begin suddenly and may lead to death if not immediately treated. Anaphylaxis includes a wide range of symptoms that can occur in many combinations. Some symptoms are not life-threatening, but the most severe restrict breathing and blood circulation. Many different parts of your body can be affected. Skinitching, hives, redness, swelling Nosesneezing, stuffy nose, runny nose Mouthitching, swelling of lips or tongue Throatitching, tightness, difficulty swallowing, hoarseness Chestshortness of breath, cough, wheeze, chest pain, tightness Heartweak pulse, passing out, shock GI tractvomiting, diarrhea, cramps Nervous systemdizziness or fainting Symptoms may begin within several minutes to several hours after exposure to the food. Sometimes the symptoms go away, only to return 2 to 4 hours later or even as many as 8 hours later. When you begin to experience symptoms, you must seek immediate medical attention because anaphylaxis can be lifethreatening. Anaphylaxis caused by an allergic reaction to a certain food is highly unpredictable. The severity of a given attack does not predict the severity of subsequent attacks. The response will vary depending on several factors, such as
Your sensitivity to the food How much of the food you are exposed to How the food enters your body Any anaphylactic reaction may become dangerous and must be evaluated by a healthcare professional. Food allergy is the leading cause of anaphylaxis. However, medications, insect stings, and latex can also cause an allergic reaction that leads to anaphylaxis.
Anaphylaxis is highly likely if at least one of the following three conditions occurs: 1. Within minutes or several hours of the onset of an illness, a person has skin symptoms (redness, itching, hives) or swollen lips and either Difficulty breathing, or A drop in blood pressure 2. A person was exposed to an allergen likely to cause an allergic reaction, and, within minutes or several hours, two or more of the following symptoms occur: Skin symptoms or swollen lips Difficulty breathing A drop in blood pressure GI symptoms such as vomiting, diarrhea, or cramping 3. A person exposed to an allergen previously known to cause an allergic reaction in that person experiences a drop in blood pressure.
Children usually outgrow their egg, milk, and soy allergies, but people who develop allergies as adults usually have their allergies for life. Children generally do not outgrow their allergy to peanut.
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Finally, foods that are eaten routinely increase the likelihood that a person will develop allergies to that food. In Japan, for example, rice allergy is more frequent than in the United States, and in Scandinavia, codfish allergy is more common than in the United States.
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FOOD ALLERGY: PREGNANCY, BREASTFEEDING, AND INTRODUCING SOLID FOODS TO YOUR BABY
Healthcare experts still do not have enough conclusive evidence to tell pregnant women, nursing mothers, and mothers of infants how to prevent food allergy from developing in their children. Be sure to talk with your healthcare professional before changing your diet or your babys diet. Here is what healthcare experts know now: Pregnancy When you are pregnant, you should eat a balanced diet. If you are allergic to a food, you should avoid it. If you are not allergic to foodssuch as egg, tree nuts, peanut, fish, or cows milk (all highly allergenic), you should not avoid them because there is no conclusive evidence that avoiding these foods will prevent food allergy from developing in your infant in the future. Breastfeeding Healthcare experts recommend that mothers feed their babies only breast milk for the first 4 months of life because of the health benefits of breastfeeding. Mothers who breastfeed do not need to avoid foods that are considered to be highly allergenic because there is no conclusive evidence that avoiding these foods will prevent food allergy from developing in their infants. Introducing Solid Foods Healthcare experts in the United States currently suggest that you do not introduce solid food into your babys diet until 4 to 6 months of age. There is no conclusive evidence to suggest that you should delay the introduction of solid foods beyond 4 to 6 months of age. There is no conclusive evidence to suggest that you should delay the introduction of the most common potentially allergenic foods (milk, egg, peanut) beyond 4 to 6 months of age. Delay will not prevent your child from developing an allergy in the future.
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Food additives
NIAID I FOOD ALLERGY
Another type of food intolerance is a reaction to certain products that are added to food to enhance taste, add color, or protect against the growth of microbes. Several compounds such as MSG (monosodium glutamate) and sulfites are tied to reactions that can be confused with food allergy.
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MSG is a flavor enhancer. When taken in large amounts, it can cause some of the following: Flushing Sensations of warmth Headache Chest discomfort These passing reactions occur rapidly after eating large amounts of food to which MSG has been added. Sulfites are found in food for several reasons: They have been added to increase crispness or prevent mold growth. They occur naturally in the food. They have been generated during the winemaking process. Sulfites can cause breathing problems in people with asthma. The Food and Drug Administration (FDA) has banned sulfites as spray-on preservatives for fresh fruits and vegetables. When sulfites are present in foods, they are listed on ingredient labels.
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Gluten intolerance
Gluten is a part of wheat, barley, and rye. Gluten intolerance is associated with celiac disease, also called gluten-sensitive enteropathy. This disease develops when the immune system responds abnormally to gluten. This abnormal response does not involve IgE antibody and is not considered a food allergy.
Food poisoning
Some of the symptoms of food allergy, such as abdominal cramping, are common to food poisoning. However, food poisoning is caused by microbes, such as bacteria, and bacterial products, such as toxins, that can contaminate meats and dairy products.
Histamine toxicity
Fish, such as tuna and mackerel that are not refrigerated properly and become contaminated by bacteria, may contain very high levels of histamine. A person who eats such fish may show symptoms that are similar to food allergy. However, this reaction is not a true allergic reaction. Instead, the reaction is called histamine toxicity or scombroid food poisoning.
NIAID I FOOD ALLERGY
Other
Several other conditions, such as ulcers and cancers of the GI tract, cause some of the same symptoms as food allergy. These symptoms, which include vomiting, diarrhea, and cramping abdominal pain, become worse when you eat.
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Did anyone else who ate the same food get sick? Did you take allergy medicines, and if so, did they help? (Antihistamines should relieve hives, for example.)
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Diet Diary
Sometimes your healthcare professional cant make a diagnosis based only on your history. In that case, you may be asked to keep a record of what you eat and whether you have a reaction. This diet diary contains more details about the foods you eat than your history. From the diary, you and your healthcare professional may be able to identify a consistent pattern in your reactions.
Elimination Diet
The next step some healthcare professionals use is a limited elimination diet, in which the food that is suspected of causing an allergic reaction is removed from your diet. For example, if you suspect you are allergic to egg, your healthcare professional will instruct you to eliminate this one food from your diet. The limited elimination diet is done under the direction of your healthcare professional.
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Blood Test
Instead of the skin prick test, your healthcare professional can take a blood sample to measure the levels of food-specific IgE antibodies. As with skin prick testing, positive blood tests do not necessarily mean that you have a food allergy. Your healthcare professional must combine these test results with information about your history of reactions to food to make an accurate diagnosis of food allergy.
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Keep clean
Simple measures of cleanliness can remove most allergens from the environment of a person with food allergy. For example, simply washing your hands with soap and water will remove peanut allergens, and most household cleaners will remove allergens from surfaces.
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Mild symptoms
Talk to your healthcare professional to find out what medicines may relieve mild food allergy symptoms that are not part of an anaphylactic reaction. However, be aware that it is very hard for you to know which reactions are mild and which may lead to anaphylaxis.
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Glossary
allergena substance that causes an allergic reaction. allergenicdescribes a substance that produces an allergic reaction. anaphylaxisa severe reaction to an allergen that may lead to death. antibodya protein molecule tailor-made by the immune system to detect and help destroy invaders, such as bacteria, viruses, and toxins. bacteriasingle-celled microbes that have no nucleus. Some bacteria are potentially disease causing. basophilswhite blood cells that contribute to allergic inflammatory reactions. celiac diseasean autoimmune disease of the digestive system that damages the small intestine and interferes with the absorption of the nutritional content of food. People who have celiac disease cannot tolerate gluten (a protein in wheat, rye, and barley). eczemathe term for a group of allergic conditions that causes the skin to become inflamed and is characterized by redness, itching, and oozing lesions that become crusty. The most common type of eczema is known as atopic dermatitis, or atopic eczema, and is particularly common in young children and infants.
NIAID I FOOD ALLERGY
elimination dietremoval of certain foods from a persons diet. enzymea protein produced by living cells that promotes specific biochemical reactions.
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epinephrinea hormone, also called adrenaline, that works rapidly to constrict blood vessels, preventing them from leaking fluid. It also relaxes airways, relieves cramping in the gastrointestinal tract, decreases swelling, and blocks itching and hives. Epinephrine is the drug in an EpiPen used to counter an anaphylactic reaction. esophagusthe passageway through which food moves from the throat to the stomach. extracta liquid preparation containing food allergens from specific foods. gastrointestinal (GI) tractthe organ system of the body that includes the esophagus, stomach, and small and large intestines. histaminea chemical stored in the granules of mast cells and basophils prior to release. histamine toxicitya reaction, which resembles an allergic reaction, to eating foods containing high levels of histamine. hivesa raised, itchy area of skin that is usually a sign of an allergic reaction. immune systema complex network of cells, tissues, and organs that defends the body against attacks by disease-causing microbes. immunoglobulinone of a large family of proteins, also known as antibody. lactasethe enzyme responsible for breaking down lactose in the gut. Lactase is produced by cells lining the small intestine. lactose intolerancethe inability to digest lactose, a kind of sugar found in milk and other food products, because of a shortage of the enzyme lactase.
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mast cellslarge granule-containing cells that are found in body tissues where typical allergic reactions occur. microbestiny life forms, such as bacteria and fungi, that are visible only under a microscope. They may cause disease. moleculea group of atoms chemically joined together. In a cell, examples of different molecules include proteins, fats, and carbohydrates. proteinslarge molecules composed of one or more chains of amino acids. tolerance (to food)a state in which a person with a food allergy fails to develop allergic reactions after ingesting specific foods. This lack of response is sustained over a long period of time. tissuesgroups of cells that have a similar structure and work together to perform a specific function. toxinsagents produced by plants and bacteria that are poisonous and may also trigger allergic reactions.
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More Information
General Information
National Institute of Allergy and Infectious Diseases National Institutes of Health 6610 Rockledge Drive, MSC 6612 Bethesda, MD 208926612 8662844107 or 3014965717 www.niaid.nih.gov National Library of Medicine MedlinePlus 8600 Rockville Pike Bethesda, MD 20894 888FINDNLM (8883463656) or 3015945983 www.medlineplus.gov Allergy & Asthma Network Mothers of Asthmatics 8201 Greensboro Drive, Suite 200 McLean, VA 22102 8008784403 www.aanma.org American Academy of Allergy, Asthma & Immunology 555 East Wells Street, Suite 1100 Milwaukee, WI 532023823 4142726071 www.aaaai.org American Academy of Pediatrics 141 Northwest Point Boulevard Elk Grove Village, IL 600071098 8004339016 or 8474344000 www.aap.org
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American College of Allergy, Asthma & Immunology 85 West Algonquin Road, Suite 550 Arlington Heights, IL 60005 8474171200 www.acaai.org Asthma and Allergy Foundation of America 8201 Corporate Drive, Suite 1000 Landover, MD 20785 8007ASTHMA (8007278462) or 2024667643 www.aafa.org Food Allergy and Anaphylaxis Network 11781 Lee Jackson Highway, Suite 160 Fairfax, VA 220333309 8009294040 www.foodallergy.org Food Allergy Initiative 515 Madison Avenue, Suite 1912 New York, NY 100225403 855FAI9604 (8553249604) www.faiusa.org
Allergy Extracts
Food and Drug Administration Center for Biologics Evaluation and Research 10903 New Hampshire Avenue Silver Spring, MD 209930002 888INFOFDA (8884636332) www.fda.gov/cber
NIAID I FOOD ALLERGY
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Eczema
National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse National Institutes of Health 1 AMS Circle Bethesda, MD 208923675 87722NIAMS (8772264267) or 3014954484 www.niams.nih.gov American Academy of Dermatology P.O. Box 4014 Schaumburg, IL 601684014 866503SKIN (8665037546) or 8472471280 www.aad.org National Eczema Association for Science and Education 4460 Redwood Highway, Suite 16D San Rafael, CA 949031953 8008187546 or 4154993474 www.nationaleczema.org
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Food Contents
U.S. Department of Agriculture Food and Nutrition Information Center National Agricultural Library 10301 Baltimore Avenue, Room 105 Beltsville, MD 20705 3015045414 www.nal.usda.gov/fnic
Food Facts
American Dietetic Association 120 South Riverside Plaza, Suite 2000 Chicago, IL 606066995 8008771600 or 3128990040 www.eatright.org/public
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Credits
Cover Getty Images Facing Contents iStockphoto Page 2 Page 4 Page 5 Page 7 Page 9 Page 10 Page 11 Page 12 Page 13 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 22 Page 23 Page 25 iStockphoto iStockphoto iStockphoto iStockphoto iStockphoto (top to bottom) iStockphoto iStockphoto iStockphoto iStockphoto iStockphoto iStockphoto iStockphoto iStockphoto NIAID
NIAID I FOOD ALLERGY
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National Institute of Allergy and Infectious Diseases NIH Publication No. 12-5518 July 2012 www.niaid.nih.gov